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General NPI Number Information
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NPI Number | 1952435240
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Entity Type | Individual
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Provider Name | REAGAN L EDWARDS PT
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Gender | Female
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 12011 LEE JACKSON MEMORIAL HWY
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City | FAIRFAX
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State | VA
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Zip | 22033-3310
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Country | US
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Telephone | 703-383-5497
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Fax | 703-383-5580
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Provider Business Mailing Address
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Address Line | 2101 E JEFFERSON ST KAISER PERMANENTE ATTN: THERESA A JACKSON
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City | ROCKVILLE
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State | MD
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Zip | 20852-4908
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Country | US
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Telephone | 301-816-7405
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Fax | 301-816-1740
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305204049
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License Number State | VA
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